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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 42. Go back in thread:
Posted by judy1 on October 25, 2001, at 18:59:00
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
I'm interested in your doctor's choice of lamictal for panic disorder- or are you treating bipolar disorder also? Klonopin has been the most efficacious med for panic for me with minimal sedation, although when times are tough I take xanax prn. GI problems are fairly common with panic disorder, I hope you get the correct diagnosis and treatment- Judy
Posted by daveman on October 25, 2001, at 22:28:52
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by janejj on October 25, 2001, at 12:13:56
> Hi,
>
> Ativan (lorazepamO is fairly mild, its used in children, probably less sedating than xanax.!!According to the info I've read, Ativan is FDA approved (US) as a sleeping pill, while Xanax and Klonopin are not. My doc says in his experience, Ativan is more sedating than Klonopin, which is much more sedating than Xanax.
I've never taken Ativan, but I have taken Valium, Xanax, Klonopin and (once, many years ago) Dalmane. Of those, Xanax was by far the least sedating, all of the others knocked me out. But that's me, YMMV.
Dave
Posted by Elizabeth on October 26, 2001, at 11:56:07
In reply to Re: Which benzo is *least* sedating? +other stuff » janejj, posted by daveman on October 25, 2001, at 22:28:52
> According to the info I've read, Ativan is FDA approved (US) as a sleeping pill, while Xanax and Klonopin are not. My doc says in his experience, Ativan is more sedating than Klonopin, which is much more sedating than Xanax.
What doses does he consider to be equivalent for these three drugs?
FDA approval indicates what the drug company has decided to market the medication for -- no more. Prozac is just as effective for panic disorder as Paxil is, even though Paxil was approved first. (For that matter, MAOIs are probably more effective than SSRIs for panic disorder and social phobia, even though the nonselective MAOIs have never been approved for any indication other than depression.)
> I've never taken Ativan, but I have taken Valium, Xanax, Klonopin and (once, many years ago) Dalmane. Of those, Xanax was by far the least sedating, all of the others knocked me out. But that's me, YMMV.
YMMV, definitely.
I don't find any of them sedating. I've taken Klonopin (up to 3 mg at a time), Xanax (2 mg), Ativan (3 mg, plus several times IM at doses I never knew), Valium (40 mg), Librium (100 mg), Versed (I think 2 or 3 mg IV), Restoril (45 mg), ProSom (don't remember the dose), and probably others that I'm forgetting. I think that most people usually grow tolerant to the sedation from benzos; if you don't, count yourself lucky and use one as a sleeping pill.
-elizabeth
Posted by Gracie2 on October 28, 2001, at 12:56:57
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
Your fatigue may be cause by celiac disease which can also result in malabsorbtion of vitamins. You might want to take care of that first, see if your sedation goes away.
-Gracie
Posted by Daveman on October 29, 2001, at 22:29:45
In reply to Re: Which benzo is *least* sedating? +other stuff » daveman, posted by Elizabeth on October 26, 2001, at 11:56:07
> > According to the info I've read, Ativan is FDA approved (US) as a sleeping pill, while Xanax and Klonopin are not. My doc says in his experience, Ativan is more sedating than Klonopin, which is much more sedating than Xanax.
>
> What doses does he consider to be equivalent for these three drugs?I've never discussed Ativan doses with him since I've never been on it. We did discuss Xanax vs. Klonopin, but he does not like "comparative" doses because the drugs have different reactions in different patients. OTOH when he switched me from Xanax to Klonopin we started at the same daily dose, 2 mg., given 2x rather than 3x daily, but I soon found I could reduce to 1 mg. per day with the same therapeutic effect. So for me, I'd say Klonopin was twice as strong; but also, as I've said, I found Klonopin very sedating. I'm willing to wager that I would have developed tolerance to this sedation, but at this point in my therapy the Celexa began working and I was tapered off the Klonopin. Have not taken any benzo in nine months, don't miss them at all.
Dave
Posted by Elizabeth on October 30, 2001, at 12:21:47
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Daveman on October 29, 2001, at 22:29:45
> I've never discussed Ativan doses with him since I've never been on it. We did discuss Xanax vs. Klonopin, but he does not like "comparative" doses because the drugs have different reactions in different patients.
Exactly. And it's hard to say that one is "more sedating" than another when the effective doses vary from patient to patient. (For the record, it's generally accepted that Xanax is the most potent anxiolytic of these three and Ativan is the least.)
> OTOH when he switched me from Xanax to Klonopin we started at the same daily dose, 2 mg., given 2x rather than 3x daily, but I soon found I could reduce to 1 mg. per day with the same therapeutic effect.
That's pretty reasonable: 0.5 mg of Xanax is pretty close to being equianxiolytic with 0.5 mg of Klonopin (although the Klonopin will last longer).
-e
Posted by Daveman on October 30, 2001, at 21:42:09
In reply to Re: Which benzo is *least* sedating? +other stuff » Daveman, posted by Elizabeth on October 30, 2001, at 12:21:47
> > OTOH when he switched me from Xanax to Klonopin we started at the same daily dose, 2 mg., given 2x rather than 3x daily, but I soon found I could reduce to 1 mg. per day with the same therapeutic effect.
>
> That's pretty reasonable: 0.5 mg of Xanax is pretty close to being equianxiolytic with 0.5 mg of Klonopin (although the Klonopin will last longer).I found Klonopin "lower" and "longer"; that is, Klonopin did not give me the same kind of mood elevation as Xanax, but lasted about 6 hours (as opposed to 3-4 hours with Xanax). Xanax also had a much more pronounced "whoosh" (not a medical term I know, but descriptive nonetheless) both in and out of my system. I found it much harder to manage Xanax and can understand why it is addictive to those with tendencies towards drug abuse. If you go back and read my early posts about Xanax (I was very sick at that time) you can see how much Xanax scared me.
Dave
Posted by Mitch on October 30, 2001, at 23:02:04
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
> Hi everyone.
>
> I am on 3mg per day Xanax and 200mg per day Lamictal for PD and have been on this combo for a few months with reasonable success.
> Lately I have been becoming more and more fatigued to the point where it is adversely affecting my work.
> I don't know what is going on, but I am wondering if Ativan or Klonopin is less sedating than Xanax? Maybe this could help me in the short term. Personally I suspect Lamictal poop-out is starting to happen, but if that is the case I still need to buy some time to find an alternative.
>
> On the side, I have turned up very high gliadin antibody levels and am going to the gastrodoc next month on suspicion of celiac disease (maybe people with plain ol' IBS should see their doc for celiac testing?).
> I think I will be quite pissed if I have been treated symptomatically for 10 years with hellish ADs while celiac has been the underlying cause and steadily ripping my guts apart and playing havoc with my nervous system.
>
> Such is life.
>
> Thrud
>I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
I also have IBS/d and I never have heard of "celiac disease" before. I know what you mean by "hellish AD's"!! I get the most benefit from SSri's, but they DO rip my guts to shreds. I have tried adding nortriptyline (20-30mg/day) to the SSRi and it did help a lot, BUT I didn't like the sfx from the NT!Mitch
Posted by Mr. Scott on October 30, 2001, at 23:43:02
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
In my experience.. of the 3 benzo's you mentioned Xanax is the least sedating and Klonopin the worst. I have both heard and experienced first hand that Serax and Tranxene (not the best for Panic) have less cognitive/sedative effects.
Scott
Posted by Mr. Scott on October 30, 2001, at 23:45:42
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by janejj on October 25, 2001, at 12:13:56
What is Celiac Disease????
Posted by Thrud on October 31, 2001, at 1:15:19
In reply to Celiac Disease?, posted by Mr. Scott on October 30, 2001, at 23:45:42
> What is Celiac Disease????
Hi Mr Scott.
Go to www.celiac.com
It is quite a comprehensive site on the topic. Celiac disease is not really a "disease" but rather an immune response to eating certain proteins, usually gluten and/or casein found in grains and dairy foods, respectively. It is becoming more well known as "gluten intolerance", although this is a rather simplistic description.It seems that the symptoms vary depending upon whether it is juvenile or adult onset, and US PCPs are only familiar with the juvenile symptoms (and only vaguely at that) and adult victims are almost universally misdiagnosed (I read that for every diagnosed celiac in the US there are 20-100 mis- or undiagnosed). This is not surprising since the adult symptoms are usually some sort of IBS-like discomfort and *psychiatric symptoms* usually anxiety, depression or schizophrenia.
In celiac disease, the IBS symptoms are caused by the immune system damaging the small intestine after ingesting gluten and/or casein, while the psychiatric symptoms are caused by the subsequent improper digestion, leading to malnutrition in certain materials and the accumulation of opiate-like chemicals in the bloodstream which then cross to the brain.
Since just about everybody who has mental illness has IBS as well it is hardly surprising that celiac disease is almost never diagnosed amongst adults. I actually diagnosed myself by pure chance when I noticed one of the possible symptoms were peculiar problems with tooth enamel which I happened to have. I then demanded blood tests from an indifferent PCP. I knew I was right when I got the call to come back to see him....(BTW if you are overweight like me, don't let the doc use that as a reason that you can't have celiac disease since I reminded him that every AD or benzo I've ever been on makes me overweight)Thank God for the internet and Google search. Do a google search for celiac + depression and see how many returns you get. You will see how strongly they can be related.
The road back from celiac is not easy: a very strict diet must be followed for life. For me, if this means recovery or even significant improvement in my condition it will be well, well worth it.ADs for an immuno-digestive problem? Hasn't worked for me. I hope it hasn't been undiagnosed for so long that any permanent neurological damage has occured; I've had that dental problem (and depression, PD) for over ten years.
I hope I've helped you some.
Thrud
Posted by Thrud on October 31, 2001, at 1:22:59
In reply to Celiac Disease?, posted by Mr. Scott on October 30, 2001, at 23:45:42
Thank you all very much.
I guess the overall concensus is that Xanax is probably the least sedating yet most effective, but as always YMMV.
This is not really good news for me, but I think I will try Klonopin anyway and see what happens. Besides, I don't really like the rollercoaster ride I get with the short acting Xanax; it really lets me know when I've skipped a dose.
Thanks again everyone.
Thrud
Posted by Elizabeth on October 31, 2001, at 22:26:49
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by Mitch on October 30, 2001, at 23:02:04
> I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
I didn't experience any sedation on Librium. I've been interested in finding out whether I could take a high dose of it for panic disorder (I had already been taking quite a bit -- 50 mg q.i.d. -- when I gave up on it, but I probably could have gone higher without any problems). But there's little evidence supporting the use of low-potency benzos in PD.
> I also have IBS/d and I never have heard of "celiac disease" before. I know what you mean by "hellish AD's"!! I get the most benefit from SSri's, but they DO rip my guts to shreds. I have tried adding nortriptyline (20-30mg/day) to the SSRi and it did help a lot, BUT I didn't like the sfx from the NT!
What side effects did NT have that bothered you?
(BTW, what did you mean by "IBS/d?")
-elizabeth
Posted by Mitch on October 31, 2001, at 23:28:28
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on October 31, 2001, at 22:26:49
> > I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
>
> I didn't experience any sedation on Librium. I've been interested in finding out whether I could take a high dose of it for panic disorder (I had already been taking quite a bit -- 50 mg q.i.d. -- when I gave up on it, but I probably could have gone higher without any problems). But there's little evidence supporting the use of low-potency benzos in PD.Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks. It is true that the low-potency benzos work better for GAD symptoms. The Klonopin I take will prevent a panic attack, but at the cost of amblyopia, cognitive dysfunction, etc. ChlorD. would prevent a panic attack for me *most* of the time-but it wasn't *reliably* effective. The ChlorD. was also a lot less depressogenic (?) than Valium.
>
> > I also have IBS/d and I never have heard of "celiac disease" before. I know what you mean by "hellish AD's"!! I get the most benefit from SSri's, but they DO rip my guts to shreds. I have tried adding nortriptyline (20-30mg/day) to the SSRi and it did help a lot, BUT I didn't like the sfx from the NT!
>
> What side effects did NT have that bothered you?Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.
>
> (BTW, what did you mean by "IBS/d?")Diarrhea predominant IBS. If I add the NT to an SSRi it tends to dampen that problem (anticholinergic effects). Remeron worked even better for that (IBS/d)-I believe because of the 5-HT3 antagonism. But it hits far more receptors than the NT did! Definitely the NT was less antihistaminic and I didn't get irritable on it (no alpha-2 antagonism).
BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids. I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well. I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
>
> -elizabeth
Posted by Gracie2 on November 1, 2001, at 9:07:40
In reply to Which benzo is *least* sedating? +other stuff, posted by Thrud on October 25, 2001, at 1:11:40
I am not sure how celiac disease is diagnosed but if it requires a barium enema or a colonoscopy, I would insist on a sedative before the procedure.
I would insist on it.
-Gracie the X-Ray Tech
Posted by Elizabeth on November 1, 2001, at 14:43:29
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Mitch on October 31, 2001, at 23:28:28
> Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks.
I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
> It is true that the low-potency benzos work better for GAD symptoms.
I've never seen any data to suggest that. Klonopin, Ativan, and Xanax have all been found effective for GAD as well as PD.
[re nortriptyline side effects]
> Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.Huh. Those are pretty weird, except for the tachycardia. I wonder what was going on there.
> BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids.
It's bloody expensive, too.
> I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well.
Sure -- so would augmenting with Remeron. I think Zofran was being studied as a possible anxiolytic, too, but I don't think anything came of it.
> I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
Except for one time when I tried to start on too high a dose of buprenorphine (I need to start at 1/2 mL and then increase to 1 mL), I've never gotten nausea from opioids. How much morphine were you on?
-elizabeth
Posted by Mitch on November 1, 2001, at 23:37:38
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on November 1, 2001, at 14:43:29
> > Wow! I used to get by OK on 10mg tid! Of course, I am med sensitive and it generally takes about 1/6 to 1/3 of anything to do the same thing for me that it takes for other folks.
>> I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
Nah, it's not that. There is something else going on. I have had blood levels drawn for NT and lithium, i.e., and they show low or sub-therapeutic levels and I am experiencing all sorts of weird sfx. One thing my pdoc mentioned is the possibility that my receptor densities tend to be high in general for unknown reasons, which might explain the "knee-jerk" reaction to meds. I also think that it is related to neuronal firing instability as in epilepsy (I have family history of inheritable epilepsy). A neurologist I saw once told me I had an "atypical bipolar syndrome" or "possible frontal lobe dysfunction". The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
>
> > It is true that the low-potency benzos work better for GAD symptoms.
>
> I've never seen any data to suggest that. Klonopin, Ativan, and Xanax have all been found effective for GAD as well as PD.From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
>
> [re nortriptyline side effects]
> > Mainly cold extremities (cold nose/hands, ie.), also got some facial numbness on the front of my face and forehead (that was like high-dose Gabitril in some ways). Also, my arms and legs would go to sleep easily and get numb and tingle. A little bit of tachycardia as well.
>
> Huh. Those are pretty weird, except for the tachycardia. I wonder what was going on there.I am guessing it has something to do with vasoconstriction that is experienced with drinking a lot of coffee or taking pseudo-ephedrine for example. The increased noradrenaline levels I think account for that.
>
> > BTW, I am thinking about starting a thread regarding Odansentron (ZOFRAN). It is a selective 5-HT3 antagonist which is used for chemotherapy/radiotherapy/postsurgical nausea and vomiting from the chemo drugs or from anesthetics/opioids.
>
> It's bloody expensive, too.
Yes, I am aware of that, unfortunately.>
> > I heard somewhere that it decreased alcohol cravings in some people dramatically-also if my theory is correct it should be able to reduce nausea/diarrhea from SSRI's as well.
>
> Sure -- so would augmenting with Remeron. I think Zofran was being studied as a possible anxiolytic, too, but I don't think anything came of it.No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable. I can't trust myself-it's that bad..really.
Remeron just hits way too many receptors for someone like me.>
> > I haven't brought it up to my pdoc just yet. I was given Odansentron immediately after my thyroid surgery and I was sitting up in bed shortly after +morphine and eating a big tray of food with no nausea!
>
> Except for one time when I tried to start on too high a dose of buprenorphine (I need to start at 1/2 mL and then increase to 1 mL), I've never gotten nausea from opioids. How much morphine were you on?Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but. I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use, and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
Mitch
Posted by Thrud on November 3, 2001, at 7:24:37
In reply to Celiac disease - Thrud, posted by Gracie2 on November 1, 2001, at 9:07:40
>
> I am not sure how celiac disease is diagnosed but if it requires a barium enema or a colonoscopy, I would insist on a sedative before the procedure.
> I would insist on it.
> -Gracie the X-Ray Tech
It is first screened by testing the levels of certain antibodies in the blood; no big deal, just the usual, 'you might feel a little prick...'These blood tests indicated positive results for Celiac Disease in my case. The final step will be a small intestine biopsy which I will be sedated for. I hope they're not thinking of using some benzo...I think I would prove somewhat resistant to the sedative effect!
Thrud
Posted by Thrud on November 3, 2001, at 7:30:24
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by judy1 on October 25, 2001, at 18:59:00
> I'm interested in your doctor's choice of lamictal for panic disorder- or are you treating bipolar disorder also?
No. PD+unipolar depression. It was a choice made out of desperation because other medications give me such strong sexual dysfunction. Benzos by themselves will not relieve my chronic fatigue; it seems that I need some sort of stimulating med as well.
>I hope you get the correct diagnosis and treatment- Judy
Thanks. I hope you receive the same.
Thrud
Posted by Thrud on November 3, 2001, at 7:34:41
In reply to Re: Which benzo is least sedating? » Thrud, posted by Elizabeth on October 25, 2001, at 12:48:20
> It's really not possible to predict -- it's different for everybody. I would try Klonopin first, since it has the additional advantage of being long-acting. (A disadvantage of Klonopin is that it doesn't start working as fast as Xanax, but that shouldn't be an issue since you're taking it around-the-clock.)
>
> Ativan is less potent than Klonopin and Xanax, so you should expect to need a higher dose of that if you decide to try it. You may find that you need a slightly higher total daily dose of Klonopin than of Xanax, too.
Some people rave on about 'Tranxene' (its supposed to be a 'clean burner'). I guess this is not a triazolam and therefore not as potent as Xanax etc? Unfortunately I do need a potent benzo.Thrud
Posted by Thrud on November 3, 2001, at 7:37:54
In reply to Re: Which benzo is *least* sedating? +other stuff » Thrud, posted by Mitch on October 30, 2001, at 23:02:04
> I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
From what I've heard it is not a very potent benzo, at least compared to Xanax and the like. How did you find it?
Thrud
Posted by Thrud on November 3, 2001, at 7:39:17
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by Thrud on November 3, 2001, at 7:37:54
Posted by Mitch on November 3, 2001, at 9:53:02
In reply to Re: Which benzo is *least* sedating? +other stuff, posted by Thrud on November 3, 2001, at 7:37:54
> > I have found that cheap old generic chlordiazepoxide (Librium) was the least sedating benzo that I have ever taken.
>
> From what I've heard it is not a very potent benzo, at least compared to Xanax and the like. How did you find it?
>
> Thrud
It worked really well for GAD-type symptoms. High-potency BZD's tend to produce a "drunk" like feeling (Xanax), memory problems (Ativan), or fatigue (Klonopin-I am taking low-dose of now). Diazepam worked the best for GAD (in my case), but it clearly worsened my depressive symptoms. So, for a year or two I kind of bounced back and forth between Chlord. and diazepam. The Chlord. definitely provoked less depression. Hmm.. maybe that is why they included it in Limbitrol tabs (amitriptyline+chlordiazepoxide)??? That that was the first med that contained an BZD that I was ever prescribed (back in 1979).Mitch
Posted by Elizabeth on November 3, 2001, at 10:54:26
In reply to Re: Which benzo is *least* sedating? +other stuff » Elizabeth, posted by Mitch on November 1, 2001, at 23:37:38
> > I've heard many people say they are generally sensitive to meds. I wonder how that could come about (other than something major like liver disease).
>
> Nah, it's not that. There is something else going on.I know that; I'm sure if all these people had liver disease, at least *some* of them would have found out by now.
> I have had blood levels drawn for NT and lithium, i.e., and they show low or sub-therapeutic levels and I am experiencing all sorts of weird sfx. One thing my pdoc mentioned is the possibility that my receptor densities tend to be high in general for unknown reasons, which might explain the "knee-jerk" reaction to meds. I also think that it is related to neuronal firing instability as in epilepsy (I have family history of inheritable epilepsy). A neurologist I saw once told me I had an "atypical bipolar syndrome" or "possible frontal lobe dysfunction".
Hand-waving. You can come up with all sorts of theories, but the fact is, we don't know what causes any of this. I hope we will one day, though.
> The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
ADD + anxiety/agitation is really tough to treat, but I think MAOIs might be effective.
> From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
"Onto something?" I was disagreeing with you! :-) I *don't* think there is any evidence to support the idea that low-potency benzos work better in general for GAD than high-potency benzos do, although this may be true for you personally (and with regard to the benzos that are marketed and that you've tried). Different people have different reactions to benzos, just like SSRIs or any other class of drug for that matter -- some people find Klonopin more sedating than Xanax (at theoretically "equivalent" doses), others find Xanax more sedating, etc.
Librium has a reputation for having low abuse potential, so it's still used to help alcoholics detox sometimes.
> I am guessing it has something to do with vasoconstriction that is experienced with drinking a lot of coffee or taking pseudo-ephedrine for example. The increased noradrenaline levels I think account for that.
I don't know. If you were experiencing that, I would expect your blood pressure to be quite high. I've experienced actual hypertensive crisis (due to MAOI-food interaction) and what you're describing doesn't sound much like it at all.
Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?
> No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable.
Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?
> > How much morphine were you on?
>
> Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but.Oh, it was IM. Injected morphine can hit pretty hard -- its bioavailability is a lot better when it's given parenterally than orally. And you were basically opioid-naive, right? (Never taken them long-term or anything like that?) Had you had nausea from opioids before?
> I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use,
Morphine won't make *that* any better! I get horrible dry mouth from buprenorphine (morphine and hydrocodone caused it too).
> and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
Weird that the specific drugs you were given were listed on your insurance statement.
I find that opioids make me hungry, although that might just be due to relief of depression.
-elizabeth
Posted by Mitch on November 3, 2001, at 12:46:20
In reply to Re: Which benzo is *least* sedating? +other stuff » Mitch, posted by Elizabeth on November 3, 2001, at 10:54:26
> > The trick is to get me ATTENTIVE *and* CALM. I can get one or the other fairly easily, but BOTH is *THE* problem!
>
> ADD + anxiety/agitation is really tough to treat, but I think MAOIs might be effective.Elizabeth, I would definitely agree but my current pdoc won't touch them-nyet, no, nada (and perhaps for good reasons)! I even mentioned selegiline and NOPE to that one as well. Is SJW really much of an MAOI inhibitor or is most of that just BS? I was told it would be ok to experiment with that somewhat.
>
> > From personal experience, yes, Klonopin/Ativan/Xanax does the trick for panic, BUT, just ordinary anticipatory GAD-like angst- chlordiazepoxide or diazepam seemed to work much better-I think you are onto something there.
>
> "Onto something?" I was disagreeing with you!OOPs! There's my ADHD sneaking in again.
> I don't know. If you were experiencing that, I would expect your blood pressure to be quite high. I've experienced actual hypertensive crisis (due to MAOI-food interaction) and what you're describing doesn't sound much like it at all.
Well, my BP *is* much higher while taking NT or Zoloft or Effexor (not a hypertensive crisis by any means-and different sfx)! It is normal if I am not taking those meds. It is borderline high when I am taking them. (118/70 > 145/80)
All I know is that the "cold nose", clammy hands, etc. were just like when I take pseudoephedrine for a cold. Also, when I was taking Adderall (just 5mg AM)-I coud jump on a stairmaster and I would get really nasty headaches in the back of my head.
>
> Did the side effects last long (more than a few weeks, say), or were you unable to tolerate the nortriptyline long enough to find out?They were tolerable but very annoying. The Zoloft+Nortriptyline combo works fairly well for attentiveness. *If* the antihistaminic effect of the NT wasn't there it would probably be nearly ideal.
>
> > No Remeron for this dude again! For some reason anything that is an alpha-2 adrenoreceptor antagonist makes me VERY hostile and irritable.
>
> Alpha2 blockade leads to increased NE firing. But again, this is just speculative. What other drugs have caused that problem for you?Buspar(even worse than Remeron). I was told (I think by JohnX2) that its primary metabolite is also an alpha-2 antagonist.
>
> > > How much morphine were you on?
> >
> > Oh, I have no idea! They started to give me a Vicodan when I got back to the observation room, and hey my throat is sore you know??, so they gave me a morphine shot in the but.
>
> Oh, it was IM. Injected morphine can hit pretty hard -- its bioavailability is a lot better when it's given parenterally than orally. And you were basically opioid-naive, right? (Never taken them long-term or anything like that?) Had you had nausea from opioids before?No, I never had to take any opioids long term. Yes, the Vicodans they sent me home with *did* make me a little nauseous, but it was tolerable.
>
> > I just got back from surgery and my mouth was practically glued shut from all the anticholinergics they use,
>
> Morphine won't make *that* any better! I get horrible dry mouth from buprenorphine (morphine and hydrocodone caused it too).
>
> > and I was asked if I wanted to eat some soft food, have some juice, etc. I really *did* feel hungry! No nausea at all! I didn't know about the Odansentron until I got the statement from the insurance a couple of weeks later.
>
> Weird that the specific drugs you were given were listed on your insurance statement.Ooops again, it wasn't the insurance statement it was the itemized statement from the *hospital*.
>
> I find that opioids make me hungry, although that might just be due to relief of depression.Yes, I would agree with that.
Mitch>
> -elizabeth
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